Christian Financial Management Payroll Concerns

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Nov 10, 2013 (3 years and 11 months ago)

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Christian Financial Management

Payroll Concerns


Please submit this form with any documentation to address or email below


Direct Care Worker Name:

________________________________

SSN:

______
-

____
-

______

Address:

_______________________________________________



_______________________________________________



_______________________________________________

Phone Number:

(_____) ______
-

________

Cell Number:

(____) ____
-

_________

Consumer/Employer

Name:

________________________________________



I a
m missing pay for the week(s) of:

date:

from __________ to ____________

date:

from __________ to ____________

date:

from __________ to ____________




*Please submit LEGIBLE

timesheet
(s)
, which must be signed, by both the worker and the participant
for the

week(s) in question.



Taxes / Deductions were not deducted properly from my paycheck.

Please describe
:

________________________________________________________________________
________________________________________________________________________
______
__________________________________________________
________________
________________________________________________________________________

Attach any documentation that might help resolve the issue



My rate of pay was not correct
.

o

Please state the rate you
were paid $ ___________

o

Please state
your previous hourly rate

$ ___________





My hours were incorrect
.

o

Please state pay period that was incorrect

-

From
___/___/______

To __/__/____

o

Please state the hours that you were paid for

-


_________

o

Please
state the hours that you worked

-


___________


Please submit
LEGIBLE
form and any documentation to:


MAIL







EMAIL


Christian Financial Management



concerns@christianfinancialmanagement4u.com



801 Vinial Street, 2
nd

Floor




Copy OLTL at


Pitt
sburgh, PA 15212



RA
-
oltlselfdirection@state.pa.us